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Caroselli C, Suardi LR, Besola L, Fiocco A, Colli A, Falcone M. Native-Valve Aspergillus Endocarditis: Case Report and Literature Review. Antibiotics (Basel) 2023; 12:1190. [PMID: 37508286 PMCID: PMC10376027 DOI: 10.3390/antibiotics12071190] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 07/08/2023] [Accepted: 07/10/2023] [Indexed: 07/30/2023] Open
Abstract
Aspergillus endocarditis represents the second etiological cause of prosthetic endocarditis following Candida spp. On the other hand, native-valve endocarditis due to Aspergillus are anecdotally reported with increasing numbers in the last decade due to new diagnostic technologies such as polymerase chain reaction (PCR) on samples like valve tissue or entire blood. We performed a review of the literature presenting one case report observed at Pisa University Hospital. Seventy-four case reports have been included in a period between 1950-2022. Immunocompromised status (patients with solid tumor/oncohematological cancer or transplanted patients) was confirmed to be the main risk factor for this rare opportunistic infection with a high rate of metastatic infection (above all, central nervous system) and mortality. Diagnosis relies on serum galactomannan and culture with PCR on valve tissue or whole blood. Cardiac surgery was revealed to be a life-saving priority as well as appropriate antifungal therapy including b-liposomal amphotericin or new triazoles (isavuconazole). The endocarditis team, facing negative blood culture endocarditis affecting an immunocompromised patient, should investigate this difficult-to-treat pathogen.
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Affiliation(s)
- Claudio Caroselli
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliera Universitaria Pisana, University of Pisa, 56126 Pisa, Italy
| | - Lorenzo Roberto Suardi
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliera Universitaria Pisana, University of Pisa, 56126 Pisa, Italy
| | - Laura Besola
- Cardiac Surgery Unit, Department of Surgical, Medical and Molecular Pathology and Critical Care, Azienda Ospedaliero Universitaria Pisana, University of Pisa, 56126 Pisa, Italy
| | - Alessandro Fiocco
- Cardiac Surgery Unit, Department of Surgical, Medical and Molecular Pathology and Critical Care, Azienda Ospedaliero Universitaria Pisana, University of Pisa, 56126 Pisa, Italy
| | - Andrea Colli
- Cardiac Surgery Unit, Department of Surgical, Medical and Molecular Pathology and Critical Care, Azienda Ospedaliero Universitaria Pisana, University of Pisa, 56126 Pisa, Italy
| | - Marco Falcone
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliera Universitaria Pisana, University of Pisa, 56126 Pisa, Italy
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2
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Diaz-Navarro RA, Kerkhof PLM. Case report on right ventricular mural endocarditis, not diagnosed clinically, but histopathologically after cardiac surgery. Eur Heart J Case Rep 2022; 6:ytac376. [PMID: 36187935 PMCID: PMC9518669 DOI: 10.1093/ehjcr/ytac376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/16/2022] [Accepted: 09/13/2022] [Indexed: 11/14/2022]
Abstract
Abstract
Background
Right ventricular mural endocarditis (RVME) is an extremely rare type of infective endocarditis that can occur even in the absence of predisposing factors. The diagnosis is a challenge when no causative pathogen can be detected.
Case summary
A previously healthy young man was admitted to a local hospital with a diagnosis of prolonged febrile syndrome and treated for acute sinusitis. As complaints returned, he was hospitalized 3 weeks later, where an echocardiogram demonstrated multiple mobile masses in the right ventricle, and a computed tomography scan revealed extensive pulmonary thromboembolism. During surgery, the endocardial masses were excised, and the pathologist considered an inflammatory myofibroblastic tumour. Despite appropriate medication and initial improvements, the complaints persisted, and 2 weeks after the surgery, the patient returned to the hospital. Imaging studies documented reappearance to the previous findings, whereas blood cultures remained negative. During the second surgery, the new masses resembling vegetations were excised, and histologic analysis indicated infective endocarditis. Adjusted medication was given for 30 days. Just before discharge, no vegetations were seen. At follow-up, 5 years later, he was in a healthy condition.
Discussion
Despite careful examinations, initial treatments according to standard protocols were unsuccessful. At final discharge, the patient reported that a tattoo complication prior to the first hospitalization was treated by antibiotics but that he did not complete the course. This omission in the communication further complicated the diagnostic and management processes, leading to surgical interventions that could have been prevented if the neglected antibiotic course was properly disclosed.
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Affiliation(s)
- Rienzi A Diaz-Navarro
- Dept. Internal Medicine, School of Medicine and Center for Biomedical Research, Universidad de Valparaiso , Viña del Mar 2540064 , Chile
| | - Peter L M Kerkhof
- Dept. Radiology & Nuclear Medicine, Amsterdam University Medical Centers , location VUmc, Amsterdam 1007 MB , The Netherlands
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3
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Kim KC, Choi HM, Yoon YE, Cho Y, Cho GY. A Case of Aspergillus Mural Endocarditis Presenting With Complete Atrioventricular Block after Liver-Kidney Transplantation. ACTA ACUST UNITED AC 2019; 3:267-271. [PMID: 32002482 PMCID: PMC6984995 DOI: 10.1016/j.case.2019.07.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Aspergillus endocarditis is a rare but fatal complication in immunocompromised hosts. Aspergillus mural endocarditis is rapidly progressive and shows a fatal outcome. Clinical suspicion and early echocardiography are key for the diagnosis.
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Affiliation(s)
- Ki Chun Kim
- Cardiovascular Center, Seoul National University Bundang Hospital, College of Medicine, Seoul National University, Seongnam, Republic of Korea
| | - Hong-Mi Choi
- Division of Cardiology, Hallym Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea
| | - Yeonyee E Yoon
- Cardiovascular Center, Seoul National University Bundang Hospital, College of Medicine, Seoul National University, Seongnam, Republic of Korea
| | - Youngjin Cho
- Cardiovascular Center, Seoul National University Bundang Hospital, College of Medicine, Seoul National University, Seongnam, Republic of Korea
| | - Goo-Yeong Cho
- Cardiovascular Center, Seoul National University Bundang Hospital, College of Medicine, Seoul National University, Seongnam, Republic of Korea
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4
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Jones RE, Groom KM, Singh A, Lai H, Dungu JN, Medeiros F, Lal A, Barbagallo RM. Non-Valvular Cardiac Aspergilloma: A Rare Presentation of a Rare Condition. Heart Lung Circ 2019; 28:e115-e116. [DOI: 10.1016/j.hlc.2019.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 12/13/2018] [Accepted: 02/01/2019] [Indexed: 10/27/2022]
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5
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Aspergillus mural endocarditis presenting with multiple cerebral abscesses. J Cardiothorac Surg 2018; 13:107. [PMID: 30326931 PMCID: PMC6192110 DOI: 10.1186/s13019-018-0796-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 09/27/2018] [Indexed: 11/16/2022] Open
Abstract
Background Fungal endocarditis is a rare and lethal cardiac infection which most commonly presents in immunocompromised patients or patients with other predisposing conditions. In a small subset of these patients, lesions present as mural masses and do not have any involvement with native valves or implanted devices. Here we present one such case which was diagnosed in the antemortem period in time to be managed with surgical resection. Case presentation A 70 year-old female patient who presented with multiple cerebral abscesses and was found on echocardiography to have a mass along the inferior wall of the left ventricle. She underwent surgical resection which revealed an Aspergillus vegetation along the left ventricle wall without any involvement of the cardiac valves. An intraoperative photograph was obtained and is presented in this case. The patient was started on antifungal therapy and expired on day 30 of treatment. Conclusions Fungal endocarditis is a rare yet lethal disease. It can be difficult to detect and workup should be initiated immediately if there is any clinical suspicion. This is especially true in any patient with predisposing conditions or any patient who presents with undiagnosed, culture-negative fevers or evidence of embolic foci. Once diagnosis is made, early initiation of antifungal therapy coupled with aggressive surgical debridement is required for any significant chance of survival.
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6
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Aspergillus Pericarditis with Tamponade in a Renal Transplant Patient. Case Rep Cardiol 2017; 2017:7134586. [PMID: 28316844 PMCID: PMC5337835 DOI: 10.1155/2017/7134586] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 02/02/2017] [Indexed: 11/18/2022] Open
Abstract
Aspergillus pericarditis is a rare and life-threatening infection in immunosuppressed patients. It has nonspecific clinical manifestations that often mimic other disease entities especially in patients who have extensive comorbidities. Diagnosis is oftentimes delayed and rarely done antemortem. A high degree of suspicion in immunocompromised patients is necessary for evaluation and timely diagnosis. This is a case of Aspergillus pericarditis with cardiac tamponade in a renal transplant patient with liver cirrhosis. Two months after transplant, he developed decompensation of his cirrhosis from hepatitis C, acute cellular rejection, and Kluyvera bacteremia, followed by vancomycin-resistant Enterococcus faecium (VRE) bacteremia. Four months after transplant, the patient presented with lethargy and fluid overload. He subsequently developed shock and ventilator-dependent respiratory failure. An echocardiogram showed pericardial effusion with cardiac tamponade. He had emergent pericardiocentesis that showed purulent drainage. He was started on broad-spectrum antibiotics. Amphotericin B was initiated when the pericardial fluid grew mold that was later identified as Aspergillus fumigatus. The patient quickly decompensated and expired.
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7
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Tahara M, Nagai T, Takase Y, Takiguchi S, Tanaka Y, Kunihara T, Arakawa J, Nakaya K, Hamabe A, Gatate Y, Kujiraoka T, Tabata H, Katsushika S. Primary Mural Endocarditis Without Valvular Involvement. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:659-664. [PMID: 28127793 DOI: 10.7863/ultra.16.03049] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 06/03/2016] [Indexed: 06/06/2023]
Abstract
Primary mural endocarditis is an extremely rare infection in which nonvalvular endocardial involvement is seen without any cardiac structural abnormalities such as ventricular septal defects. The rapid and precise diagnosis of this disease remains challenging. We present 2 cases (67- and 47-year-old male patients) of pathologically confirmed primary mural endocarditis that could have been detected by initial transthoracic echocardiography in the emergency department. Transthoracic echocardiography and transesophageal echocardiography play critical roles in the early recognition and confirmation of primary mural endocarditis.
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Affiliation(s)
- Mai Tahara
- Department of Cardiology, Japan Self Defense Forces Central Hospital, Tokyo, Japan
| | - Tomoo Nagai
- Department of Cardiology, Japan Self Defense Forces Central Hospital, Tokyo, Japan
| | - Yoshiyuki Takase
- Department of Cardiology, Japan Self Defense Forces Central Hospital, Tokyo, Japan
| | | | - Yoshiaki Tanaka
- Department of Cardiovascular Surgery, Saitama-Eastern Cardiovascular Hospital, Koshigaya, Japan
| | - Takashi Kunihara
- Department of Cardiovascular Surgery, Cardiovascular Institute Hospital, Tokyo, Japan
| | - Junko Arakawa
- Department of Cardiology, Japan Self Defense Forces Central Hospital, Tokyo, Japan
| | - Kazuhiro Nakaya
- Department of Cardiology, Japan Self Defense Forces Central Hospital, Tokyo, Japan
| | - Akira Hamabe
- Department of Cardiology, Japan Self Defense Forces Central Hospital, Tokyo, Japan
| | - Youdou Gatate
- Department of Cardiology, KKR Mishuku Hospital, Tokyo, Japan
| | | | | | - Shuichi Katsushika
- Department of Cardiology, Japan Self Defense Forces Central Hospital, Tokyo, Japan
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8
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Kartik M, Kanala A, Sunilnadikuda, Rao SM, Prakasham PS. Invasive Mediastinal Aspergillosis in Immunocompetent Male with Invasion of Left Atrium and Hilar Structures. Indian J Crit Care Med 2017; 21:408-411. [PMID: 28701850 PMCID: PMC5492746 DOI: 10.4103/ijccm.ijccm_18_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Aspergillus is described as mould characterised by septate hyphae about 2-4μ in diameter, it is ubiquitous in nature and spreads by inhalation of spores. It causes opportunistic infections in almost six forms namely Allergic bronchopulmonary aspergillosis, Aspergillus sinusitis, Cutaneous aspergillosis, Aspergilloma, Chronic pulmonary aspergillosis, Invasive aspergillosis. Invasive aspergillosis of mediastinum in an immunocompetent patient has rarely been reported. We present a case of a young male who had presented with chest pain, cough and breathleness was later diagnosed as fulminant mediastinal aspergillosis. Incisional biopsy with histology report and endotracheal cultures helped in diagnosing mediastinal aspergillosis. Despite initiation of the right antifungal therapy and best supportive measures, patient died of septic shock and multiorgan dysfunction. This case report highlights the need for higher suspicion in such cases of mediastinal masses and early tissue biopsy which can help in reducing mortality.
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Affiliation(s)
- Munta Kartik
- Department of Critical Care Medicine, Yashoda Multi-Speciality Hospital, Hyderabad, Telangana, India
| | - Arun Kanala
- Department of Cardiothoracic Surgery, Yashoda Multi-Speciality Hospital, Hyderabad, Telangana, India
| | - Sunilnadikuda
- Department of Anaesthesia and Critical Care Medicine, Yashoda Multi-Speciality Hospital, Hyderabad, Telangana, India
| | - S Manimala Rao
- Department of Critical Care Medicine, Yashoda Multi-Speciality Hospital, Hyderabad, Telangana, India
| | - P Swathi Prakasham
- Department of Microbiology, Yashoda Multi-Speciality Hospital, Hyderabad, Telangana, India
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9
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Haemophilus parainfluenzae Mural Endocarditis: Case Report and Review of the Literature. Case Rep Infect Dis 2016; 2016:3639517. [PMID: 27382494 PMCID: PMC4921150 DOI: 10.1155/2016/3639517] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 05/08/2016] [Indexed: 11/17/2022] Open
Abstract
Haemophilus parainfluenzae, which uncommonly causes endocarditis, has never been documented to cause mural involvement. A 62-year-old immunocompetent female without predisposing risk factors for endocarditis except for poor dentition presented with fever, emesis, and dysmetria. Echocardiography found a mass attached to the left ventricular wall with finger-like projections. Computed tomography showed evidence of embolic phenomena to the brain, kidneys, spleen, and colon. Cardiac MRI revealed involvement of the chordae tendineae of the anterior papillary muscles. Blood cultures grew Haemophilus parainfluenzae. The patient was treated successfully with ceftriaxone with resolution of symptoms, including neurologic deficits. After eleven days of antibiotics a worsening holosystolic murmur was discovered. Worsening mitral regurgitation on echocardiography was only found three weeks later. Nine weeks after presentation, intraoperative evaluation revealed chord rupture but no residual vegetation and mitral repair was performed. Four weeks after surgery, the patient was back to her baseline. This case illustrates the ability of Haemophilus parainfluenzae to form large mural vegetations with high propensity of embolization in otherwise normal cardiac tissue among patients with dental risk factors. It also underscores the importance of physical examination in establishing a diagnosis of endocarditis and monitoring for progression of disease.
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10
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Han KH, Kim JH, Shin SY, Jeong HY, Chu JM, Kim HS, Kim D, Shim M, Cho SH, Kim EK. A case of invasive pulmonary aspergillosis with direct invasion of the mediastinum and the left atrium in an immunocompetent patient. Tuberc Respir Dis (Seoul) 2014; 77:28-33. [PMID: 25114701 PMCID: PMC4127410 DOI: 10.4046/trd.2014.77.1.28] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Accepted: 04/09/2014] [Indexed: 12/02/2022] Open
Abstract
We report a case of invasive pulmonary aspergillosis invading the mediastinum and the left atrium. A 70-year-old woman was hospitalized for dyspnea. She had been well controlled for her diabetes mellitus and hypertension. The chest X-ray disclosed mediastinal widening, and the computed tomography scan of the chest showed that there was a large mediastinal mass and this lesion extended into the left atrium and right bronchus. The cardiac echocardiography showed that a huge mediastinal cystic mass compressed in the right atrium and a hyperechoic polypoid lesion in the left. The pathology from the bronchoscopic biopsy observed abundant fungal hyphae which was stained with periodic acid-Schiff and Gomori's methenamine silver. Despite the treatment with antifungal agents, she died from cardiac tamponade after three months. Invasive pulmonary aspergillosis, which involves the mediastinum and the heart, is very rare in immunocompetent patients.
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Affiliation(s)
- Kyu-Hyun Han
- Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Jung-Hyun Kim
- Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea. ; Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Sun Young Shin
- Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Hye Yun Jeong
- Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Ji Min Chu
- Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Hak Su Kim
- Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Daejin Kim
- Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Minjung Shim
- Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Sang-Ho Cho
- Department of Pathology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Eun Kyung Kim
- Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea. ; Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
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11
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Rajbanshi BG, Hughes JE, DeSimone DC, Maleszewski JJ, Baddour LM, Dearani JA. Surgical excision of invasive aspergillosis of the right ventricle presenting as intractable ventricular arrhythmia and right ventricular mass. Mayo Clin Proc 2012; 87:926-8. [PMID: 22958999 PMCID: PMC3498103 DOI: 10.1016/j.mayocp.2012.05.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Revised: 05/03/2012] [Accepted: 05/21/2012] [Indexed: 10/27/2022]
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12
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Singla MK, Shrivastava A, Mukherjee KC, Sodhi K. Potentially fatal tricuspid valve aspergilloma detected after laparoscopic abdominal surgery. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2011. [DOI: 10.1080/22201173.2011.10872789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- MK Singla
- Department of Cardiac Anaesthesia, SPS Apollo Hospitals, Ludhiana
| | - A Shrivastava
- Department of Cardiac Anaesthesia, SPS Apollo Hospitals, Ludhiana
| | - KC Mukherjee
- Department of Cardiac Surgery, SPS Apollo Hospitals, Ludhiana
| | - K Sodhi
- Department of Critical Care, SPS Apollo Hospitals, Ludhiana
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13
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Kemdem A, Ahmad I, Ysebrand L, Nouar E, Silance PG, Aoun M, Bron D, Vandenbossche JL. An Aspergillus myocardial abscess diagnosed by echocardiography. J Am Soc Echocardiogr 2008; 21:1177.e3-5. [PMID: 18222638 DOI: 10.1016/j.echo.2007.10.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2007] [Indexed: 11/29/2022]
Abstract
This is a rare case of Aspergillus myocardial abscess in 19-year-old woman with acute lymphoblastic leukemia treated by chemotherapy. During pancytopenia she developed invasive aspergillosis with myocardial abscess. The presence of specific antigen in the pericardial effusion was diagnostic. She died despite vigorous antifungal therapy.
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14
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Bitigen A, Bayrak F, Tigen K, Mutlu B. Large Mural Vegetation Attached to the Left Ventricular Outflow Tract: A Case Report. Heart Surg Forum 2007; 10:E1-2. [PMID: 17162391 DOI: 10.1532/hsf98.20061120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We describe an unusual case of staphylococcal endocarditis with vegetation attached to the left ventricular outflow endocardium in a patient with chronic severe aortic regurgitation that was diagnosed by transthoracic echocardiography. There was no involvement of aortic valve endocardium confirmed by transthoracic echocardiography, transesophageal echocardiography, and macroscopically in the operation. This report confirms that chronic endocardial trauma may provide a fertile nidus for the development of bacterial vegetation.
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Affiliation(s)
- Atila Bitigen
- Kosuyolu Heart and Research Hospital, Istanbul, Turkey
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15
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López-Ciudad V, Castro-Orjales MJ, León C, Sanz-Rodríguez C, de la Torre-Fernández MJ, de Juan-Romero MAP, Collell-Llach MD, Díaz-López MD. Successful treatment of Candida parapsilosis mural endocarditis with combined caspofungin and voriconazole. BMC Infect Dis 2006; 6:73. [PMID: 16608509 PMCID: PMC1458348 DOI: 10.1186/1471-2334-6-73] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2005] [Accepted: 04/11/2006] [Indexed: 11/23/2022] Open
Abstract
Background Fungal mural endocarditis is a rare entity in which the antemortem diagnosis is seldom made. Seven cases of mural endocarditis caused by Candida spp. have been collected from literature and six of these patients died after treatment with amphotericin B. Case presentation We report a case of mural endocarditis diagnosed by transesophageal echocardiogram and positive blood cultures to Candida parapsilosis. Because blood cultures continued to yield C. parapsilosis despite caspofungin monotherapy, treatment with voriconazole was added. Conclusion This is the first description of successful treatment of C. parapsilosis mural endocarditis with caspofungin and voriconazole.
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Affiliation(s)
- Víctor López-Ciudad
- Intensive Care Unit, Hospital Santa María Madre-Complejo Hospitalario de Ourense, Ourense, Spain
| | - María J Castro-Orjales
- Intensive Care Unit, Hospital Santa María Madre-Complejo Hospitalario de Ourense, Ourense, Spain
| | - Cristóbal León
- Intensive Care Unit and Emergency Service, Hospital Universitario de Valme, Sevilla, Spain
| | - César Sanz-Rodríguez
- Department of Clinical Research, Merck Sharp & Dohme de España, S.A. Madrid, Spain
| | | | | | - María D Collell-Llach
- Department of Cardiology, Hospital Santa María Madre-Complejo Hospitalario de Ourense, Ourense, Spain
| | - María D Díaz-López
- Unit of Infectious Diseases, Hospital Santa María Madre-Complejo Hospitalario de Ourense, Ourense, Spain
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16
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Caruso A, Iarussi D, Dialetto G, Covino F, Crispo C, Coppolino P, Tripoldi MF, Utili R. Unusual cases of infective endocarditis. J Am Soc Echocardiogr 2002; 15:93-5. [PMID: 11781562 DOI: 10.1067/mje.2002.116311] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We report 2 patients with unusual cases of infective endocarditis. The first patient had a large, mural vegetation on left ventricle that was diagnosed with transthoracic echocardiography; and the second patient had a large, mobile vegetation in the descending prosthetic aorta with an abscess cavity around the vessel, diagnosed by transesophageal echocardiography. This report confirms the usefulness of transthoracic and transesophageal echocardiography in the diagnosis and management of uncommon cases of endocarditis.
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Affiliation(s)
- Aurelio Caruso
- Dipartimento di Scienze Cardio-Chirurgiche, Toraciche e Respiratorie, Ospedale Monaldi, Naples, Italy
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17
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Gumbo T, Taege AJ, Mawhorter S, McHenry MC, Lytle BH, Cosgrove DM, Gordon SM. Aspergillus valve endocarditis in patients without prior cardiac surgery. Medicine (Baltimore) 2000; 79:261-8. [PMID: 10941355 DOI: 10.1097/00005792-200007000-00007] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Aspergillus native valve endocarditis in patients who have not had cardiac surgery is uncommon. We report 3 cases and review 58 other adult patients reported in the English-language literature. Sixty-seven percent of the patients had underlying immunosuppression. The clinical features were fever (74%), embolic episodes (69%), a new or changing heart murmur (41%), and sudden visual loss (13%). Patients with mural endocarditis were more often immunosuppressed, especially due to solid organ transplants, but had lower frequency of heart murmurs and embolic episodes. Echocardiography revealed a vegetation in 78% of all the cases in which it was performed. Examination and culture of biopsy material often helped to establish a diagnosis of Aspergillus infection. Twenty-five patients had an antemortem diagnosis. These patients received a mean cumulative amphotericin B dose of 27 mg/kg. Twenty percent (3/15) of patients who received combined surgical and medical therapy survived, compared to none of those who received medical therapy alone (p = 0.08). Patients who survived were not immunosuppressed. We conclude that native valve aspergillus infective endocarditis is uniformly fatal without surgical intervention and antifungal therapy.
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Affiliation(s)
- T Gumbo
- Department of Infectious Disease, Cleveland Clinic Foundation, OH 44195, USA
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18
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Navabi MA, Ajami H, Amirghofran A, Peyravian F. Aspergillus endocarditis: rare but serious Aspergillus ball obstructing the pulmonary artery. Eur J Cardiothorac Surg 1998; 14:530-2. [PMID: 9860214 DOI: 10.1016/s1010-7940(98)00217-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Aspergillus endocarditis is considered a rare complication in cardiac surgery, which is usually fatal due to unclear clinical manifestations. We present two cases with early and late post-operative Aspergillus endocarditis. Early diagnosis, more investigation for appropriate antifungal agents and their dosage, and early and aggressive surgical treatment may decrease fatality.
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Affiliation(s)
- M A Navabi
- Department of Cardiac Surgery, Shiraz University of Medical Sciences, Iran.
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19
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Alam M, Higgins R, Alam Z, Janakiraman N, Gorman M. Aspergillus fungal mass detected by transesophageal echocardiography. J Am Soc Echocardiogr 1998; 11:83-5. [PMID: 9487477 DOI: 10.1016/s0894-7317(98)70127-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Cardiac fungal infections have become more prevalent and are being diagnosed with increasing frequency. The most common infective organism is Candida albicans, followed by Aspergillus fumigatus and Cryptococcus. Cardiac involvement is usually associated with endocarditis, myocarditis, pericarditis, or intracardiac fungal mass. Early diagnosis is imperative, as these patients have poor outcome once there is cardiac involvement. In this report we describe a patient in whom an intracardiac mass was detected with transesophageal echocardiography and confirmed to be aspergillus fungal ball at surgery.
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Affiliation(s)
- M Alam
- Echocardiography Laboratory, Henry Ford Hospital, Detroit, MI 48202, USA
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20
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Lim ML, Oliver DH, Barasch E. Aspergillus Mural Vegetation Identified by Transesophageal Echocardiography. Echocardiography 1997; 14:283-286. [PMID: 11174956 DOI: 10.1111/j.1540-8175.1997.tb00723.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
We report a case of Aspergillus sp. mural or nonvalvular endocarditis, which was diagnosed by transesophageal echocardiography (TEE) as a vegetation attached to the anterolateral papillary muscle of the left ventricle. Mural endocarditis is often missed by transthoracic echocardiography (TTE) as was the case with this patient. TEE easily identified the vegetation.
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Affiliation(s)
- Marcy L. Lim
- UT-Houston Medical School, 6431 Fannin, MSB 1.257, Houston, TX 77030
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21
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Blanc-Jouvan M, Mercatello A, Duperret S, Coronel B, Bret M, Troncy J, Moskovtchenko JF. Cardiac aspergillosis: importance of transesophageal echocardiography. Intensive Care Med 1996; 22:1462. [PMID: 8986505 DOI: 10.1007/bf01709570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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22
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Kuijer PM, Kuijper EJ, van den Tweel JG, van der Lelie J. Aspergillus fumigatus, a rare cause of fatal coronary artery occlusion. Infection 1992; 20:45-7. [PMID: 1563813 DOI: 10.1007/bf01704896] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Endocarditis by Aspergillus species in patients without prior cardiovascular surgery is extremely rare and difficult to diagnose. We report and discuss a 69-year-old patient with hairy cell leukemia who developed severe bilateral pneumonia and metastatic subcutaneous nodules from which A. fumigatus was cultured. He died after 18 days of treatment with an adequate dose (0.7 mg/kg/day) of amphotericin B intravenously. Fungal endocarditis and a myocardial infarction due to a septic thrombotic occlusion of the left coronary artery by A. fumigatus appeared to be the cause of death. A. fumigatus could still be cultured from the aortic valve postmortem despite a total dose of 756 mg amphotericin B. In case of metastatic spread of Aspergillus spp., endocarditis should be suspected.
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Affiliation(s)
- P M Kuijer
- Dept. of Internal Medicine, University of Amsterdam, The Netherlands
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23
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Johnston PG, Lee J, Domanski M, Dressler F, Tucker E, Rothenberg M, Cunnion RE, Pizzo PA, Walsh TJ. Late recurrent Candida endocarditis. Chest 1991; 99:1531-3. [PMID: 2036848 DOI: 10.1378/chest.99.6.1531] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Late recurrent Candida endocarditis (LRCE) developed on a prosthetic mitral valve 22 months after treatment for primary native mitral valve endocarditis. The LRCE was difficult to diagnose; results of two dimensional echocardiography and repeated blood cultures were negative. Only transesophageal echocardiography revealed a vegetation and only lysis centrifugation blood cultures demonstrated candidemia. Postmortem examination revealed a large Candida vegetation on the prosthetic valve and Candida in the mitral valve ring. This case and a review of the literature indicate that Candida endocarditis treated with amphotericin B and prosthetic valve replacement may recur months after treatment, and that LRCE, which is difficult to diagnose and treat, may be best prevented by lifelong antifungal suppressive therapy.
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Affiliation(s)
- P G Johnston
- Medicine Branch, National Cancer Institute, National Institutes of Health, Bethesda 20892
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24
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Leung WH, Lau CP, Tai YT, Wong CK, Cheng CH. Candida right ventricular mural endocarditis complicating indwelling right atrial catheter. Chest 1990; 97:1492-3. [PMID: 2347241 DOI: 10.1378/chest.97.6.1492] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Catheter-associated candidemia is a common problem in immunocompromised patients. A leukemic patient had Candida right ventricular mural endocarditis complicating an indwelling right atrial catheter. To our knowledge, this is the first reported case of Candida right ventricular mural vegetation visualized by two-dimensional echocardiography.
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Affiliation(s)
- W H Leung
- Department of Medicine, University of Hong Kong, Queen Mary Hospital
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